Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 15109 | TX |
NPI | 1063429306 |
---|---|
Provider Name | Dr. John Robert Valant |
First Address | Cedar Hill, TX 75104-2145 |
Second Address | Cedar Hill, TX 75104-2145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |